Re-emergence tomatoes viral infections: current diagnostics, treatment options, genetic features, and future forecasts
Authors: Shopnil Akash, Md. Rezaul Islam, Md. Mominur Rahman
Journal: International Journal of Surgery (2023)

Dear Editor, During the third phase of severe acute respiratory syndrome coronavirus 2, while continuing to battle coronavirus disease 2019 (COVID-19) and monkeypox, another new viral strain identified in the subcontinent of India known as tomato flu, or tomato fever, which has been causing life-threatening problems in certain Indian states of Kerala and Tamil Nadu. Both of these states are located in southern India. There have been over 82 confirmed cases at this point, and the virial pathogen has begun to spread to other regions of India1. On 6 May, the medical journal The Lancet Respiratory Medicine published an article that said the first instance of this unexplained ailment had been recorded1. Policymakers, doctors, pharmacists, and others healthcare providers, are concerned about the rapid spread of the newly identified viral pathogen, even though, previously, this particular strain of the virus was only found in a tiny portion of Kerala. In recent times, the Anchal, Aryankavu, Neduvathur, Haryana, and Odisha are the regions of India that have been hit by the tomato flu outbreak, after Kerala and Tamil Nadu2,3. Most of those infected are youngsters less than 5 years old, and the basic indications in children with tomato flu are comparable to infected people with chikungunya and dengue. These indicators include a high fever, rashes, and severe joint pain4. The blisters, which may be relatively painful, can appear anywhere on the body and eventually grow to the size of a tomato. These blisters are similar to those found in young people infected with the monkeypox virus5. The tomato flu may cause rashes on the skin, which can lead to skin irritation. As this is the case with viral infections, other symptoms include tiredness, nausea, vomiting, diarrhea, fever, dehydration, swelling of joints, and body pains. These symptoms, together with those seen in dengue, are comparable to those seen in influenza6. To diagnose dengue, chikungunya, zika virus, varicella-zoster virus, and herpes in children exhibiting these symptoms, molecular and serological tests are conducted; Once these other possible viral infections have been eliminated, the diagnosis of tomato flu virus infection may be made with certainty1,7. However, several publications and authorities believe that head, foot, and mouth disease is more likely to be the culprit of this pathogenic infectious disease, and the majority of cases are due to the coxsackievirus 168. The genome of coxsackievirus 16 is a positive-sense, single-stranded RNA of around 7410 nucleotides in length, and it only has one open reading frame. The multiplication and reproduction of viral RNA require using 5′-untranslated region (5′-UTR) and 3′-UTR in the viral genome. The inner ribosomal entering site, which is involved in the multiplication and internal beginning of the translation of the genomic RNA, is located in the 5′-UTR, about 740 nucleotides long9. This open reading frame has 6579 nucleotides and encodes a polyprotein with 2193 amino acids, built from three structural precursors (P1, P2, and P3). VP1–VP4 are the products of the P1 polyprotein precursor’s processing into mature proteins. P2 and P3 are the precursors of the seven nonstructural proteins (2A, 2B, 2C, 3A, 3B, 3C, and 3D)10,11. Although, there is currently no particular medication available to treat the ‘tomato flu.’ According to the report of Lancet, the treatment of tomato flu is recommended as chikungunya and dengue for small children who are afflicted with this pathogenic virus: the patient is encouraged to drink enough fluids, get plenty of rest, and take sponge baths in hot water to alleviate the itching caused by rashes. Medications that lower fever, such as ibuprofen or acetaminophen, may also be used for children who will get affected. Because the tomato flu is extremely infectious, avoiding contact with other people for at least 5–7 days is strongly encouraged. Washing one’s hands often and avoiding sharing items of clothing, food, or toys with those who have the virus are two more preventative measures that should be taken1. Tomato flu can be passed from person to person through close contact with an infected patient, much like the dissemination of the common cold. This includes coming into contact with the patient’s secretions, like stool, or during activities of changing a diaper in childcare facilities12. Figure 1 is displayed tomato flu routes of transmission.Figure 1: Transmission route of tomato flu.The primary concentrates of this manuscript were the pathogenicity, virulence, genetic properties, transmission, diagnosis, and therapy, and current concerns around the globe due to tomato flu. Since the tomato flu is a newly pathogenic viral infection and has rapidly spread over the Indian subcontinent, despite the fact that no appropriate therapy was provided for managing and treating this condition. So, the global policymaker should take proper steps urgently to fight against this disease to avoid another pandemic like severe acute respiratory syndrome coronavirus 2. Besides, the approaches for preventing this disease are much the same as those described above. Since the current epidemic of COVID-19 is having a negative impact on people’s mental health, people must be made aware of this fact, and community-based counseling services should be adequate. In order to effectively deal with the ‘tomato flu’ epidemic during the COVID-19 period, cooperation between government officials, medical professionals, and the population is essential. Otherwise, another global pandemic may occur, and the global economy will collapse. Ethical approval Not applicable. Sources of funding Not applicable. Author contribution S.A.: conceptualization and writing – original draft preparation; M.M.R. and M.R.I.: writing and editing; M.R.: writing, editing, and supervision. All authors have reviewed and approved the final version of the manuscript prior to submission. Conflicts of interest disclosure The authors declare no conflicts of interest, financial or otherwise. Research registration unique identifying number (UIN) 1. Name of the registry: not required. 2. Unique identifying number or registration ID: not required. 3. Hyperlink to your specific registration (must be publicly accessible and will be checked): not required. Guarantor I, Md. Mominur Rahman (corresponding author), take full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish. Data availability All data are available within the manuscript.